Intravenous Infusion of Tranexamic Acid during Aortic Valve Replacement in a Patient with Indiopathic Thrombocytopenic Purpura
10.4326/jjcvs.41.99
- VernacularTitle:特発性血小板減少性紫斑病を合併した大動脈弁狭窄症に対する大動脈弁置換術の1例
- Author:
Masaki Hamamoto
;
Daisuke Futagami
- Publication Type:Journal Article
- Keywords:
idiopathic thrombocytopenic purpura;
aortic valve replacement;
tranexamic acid;
high-dose intravenous gammaglobulin therapy
- From:Japanese Journal of Cardiovascular Surgery
2012;41(2):99-102
- CountryJapan
- Language:Japanese
-
Abstract:
An 82-year-old woman, who had suffered from idiopathic thrombocytopenic purpura (ITP) treated with oral steroids, was admitted to our hospital with worsening exertional dyspnea. Cardiac examinations revealed severe aortic stenosis with left ventricular dysfunction. High dose intravenous gammaglobulin therapy (400 mg/kg/day) for 5 days was conducted to increase the platelet count prior to the operation. However, a decrease was observed in the platelet count from 2.1×104/mm3 on admission to 1.9×104/mm3 before surgery. Without additional therapy, aortic valve replacement using a 19 mm bioprosthesis was performed with cardiopulmonary bypass (CPB). Tranexamic acid (20 mg/kg/h) was continuously infused from the skin incision to the end of the surgery. Forty units of the platelet concentrates were transfused just after weaning from CPB. The patient had no hemorrhagic complications. We believe that intraoperative administration of tranexamic acid combined with platelet transfusion is effective to reduce perioperative bleeding for a patient with ITP unresponsive to preoperative gammaglobulin therapy.
